[0001] The present invention relates to a system for use in a procedure for improving the
sealing function of a sphincter, and in particular, to a system for use in a procedure
for improving the sealing function of the lower oesophageal sphincter.
[0002] Gastroesophageal reflux disease (GERD), sometimes commonly referred to as heartburn
is due to a failure of the lower oesophageal sphincter to function as intended. This
sphincter is located at the lower end of the oesophagus between the oesophagus and
the stomach, and along with diaphragm muscles, and indeed the sling fibres at the
top of the stomach, serves the critical function of preventing the contents of the
stomach being aspirated into the oesophagus. In many cases the only means of treating
GERD is to perform a surgical procedure known as fundoplication. During fundoplication
surgery, the fundus or upper part of the stomach (the fundus) is wrapped around the
lower portion of the oesophagus adjacent the sphincter and sutured into place so that
the lower portion of the oesophagus passes through a small tunnel of stomach muscle.
This surgery strengthens the sphincter and augments the biomechanical sealing function
of the sphincter, thereby minimising and in general preventing the aspiration of acid
from the stomach into the oesophagus.
[0003] By its nature fundoplication procedures tend to be operator dependent, with success
rates varying somewhere between 50% and 80%. Success is defined as the absence of
a requirement for drugs for symptomatic relief. Such a low success rate is undesirable.
In order to maximise the success rate there is a tendency to over-tighten the fundus
around the oesophagus. A common side effect of over-tightening the fundus around the
oesophagus in a fundoplication procedure is that a subject may subsequently experience
difficulty in swallowing food. Food is passed through the oesophagus of a normal subject
as a food bolus by a peristaltic pumping action. The peristaltic pumping action of
the oesophagus causes the lower oesophageal sphincter to dilate in preparation of
the food being delivered to the stomach. Thus, if the fundus is wrapped and sutured
too tightly around the oesophagus adjacent the sphincter, the amount to which the
sphincter can dilate is reduced, thereby presenting a restriction to the food bolus,
which in turn leads to difficulty in swallowing.
[0004] PCT Specification No.
WO 2006/090351 of McMahon et al. discloses a method and apparatus for measuring geometry and compliance in sphincters
and other narrowing regions of a vessel or lumen. The apparatus comprises an elongated
catheter having an inflatable balloon located at the distal ends thereof with the
catheter extending centrally through the balloon. An impedance planimetry measuring
system comprising stimulating electrodes and sensing electrodes are located on the
catheter within the balloon, so that when the balloon is inflated with an electrically
conductive medium, by applying a constant current to the stimulating electrodes, signals
produced on the sensing electrodes are indicative of the transverse cross-sectional
area of the balloon adjacent the respective sensing electrodes. Thus, by inflating
the balloon in a sphincter, the cross-sectional area of the sphincter may be determined
from signals read from the sensing electrodes.
[0005] There is therefore a need for a system which reduces the probability of over-tightening
of the fundus around the oesophagus adjacent the sphincter during a fundoplication
procedure, or any other procedure for enhancing the biomechanical function of the
lower oesophageal sphincter or any other sphincter.
[0006] The present invention is directed towards providing a system for use in a procedure
for improving the sealing function or enhancing the biomechanical function of a sphincter
which addresses the problems discussed above with reference to the lower oesophageal
sphincter, and similar problems which may arise in procedures for improving the sealing
function of other sphincters.
[0007] Examples not covered by the claims are also directed towards providing a device and
a system for testing the dilating response of a sphincter, and also for testing the
dilating response of a lower oesophageal sphincter in response to a simulated bolus
of food.
[0008] According to examples there is provided a device for use in a procedure for improving
a sealing function of a sphincter, the device comprising a catheter extending between
a proximal end and a distal end, a primary expandable element located on the catheter
towards the distal end thereof, the primary expandable element being adapted for inserting
in the sphincter, and a primary measuring means associated with the primary expandable
element, the primary measuring means being adapted to produce a signal indicative
of the transverse cross-sectional area of the primary expandable element, wherein
the primary expandable element is adapted to be selectively and alternately operable
in a first mode for dilating the sphincter to a desired transverse cross-sectional
area, and a second mode for progressively expanding with the sphincter as the sphincter
is dilating in response to stimulation thereof, and the primary measuring means is
adapted to be operable to produce a signal indicative of the transverse cross-sectional
area of the primary expandable element while the primary expandable element is being
operated in the first mode during the procedure for improving the sealing function
of the sphincter, and the primary measuring means is adapted to be operable to produce
a signal indicative of the transverse cross-sectional area of the primary expandable
element while the primary expandable element is being operated in the second mode
for determining the dilated transverse cross-sectional area of the sphincter.
[0009] In one embodiment the primary expandable element defines a hollow interior region,
and the primary measuring means is located in the hollow interior region thereof.
Preferably, the primary measuring means is adapted for determining the transverse
cross-sectional area of the primary expandable element.
[0010] In one embodiment the primary expandable element comprises a primary inflatable balloon,
defining the hollow interior region, and the catheter extends through the hollow interior
region of the primary balloon.
[0011] In another embodiment the primary balloon when inflated is of cylindrical configuration
defining a central longitudinal axis coinciding with a central longitudinal axis of
the catheter.
Preferably, a primary inflating medium accommodating means is provided for accommodating
an inflating medium to the primary balloon for inflating thereof. Advantageously,
the primary inflating medium accommodating means comprises a primary axial communicating
bore extending axially through the catheter from the proximal end thereof for accommodating
the inflating medium to the primary balloon.
Preferably, at least one primary radial communicating bore extends through the catheter
from the primary axial communicating bore communicating the primary axial communicating
bore with the hollow interior region of the primary balloon for accommodating the
inflating medium into the primary balloon.
[0012] In one embodiment the primary measuring means comprises at least one primary stimulating
electrode located on one of the catheter and an inner surface of the primary balloon
and at least one primary receiving electrode located on one of the catheter and the
inner surface of the primary balloon and axially spaced apart and insulated from the
primary stimulating electrode, the at least one primary receiving electrode being
responsive to a stimulating signal applied to the at least one primary stimulating
electrode for producing a resulting signal indicative of the transverse cross-sectional
area of the primary balloon when the primary balloon is inflated with an electrically
conductive inflating medium. Advantageously, a pair of axially spaced apart mutually
insulated primary stimulating electrodes are provided, and a plurality of axially
spaced apart mutually insulated primary receiving electrodes are provided between
the primary stimulating electrodes and axially spaced apart therefrom for producing
respective resulting signals indicative of the transverse cross-sectional area of
the primary balloon adjacent the corresponding primary receiving electrodes in response
to a stimulating signal applied across the primary stimulating electrodes when the
primary balloon is inflated with an electrically conductive inflating medium.
Ideally, each primary stimulating electrode and each primary receiving electrode is
provided on the catheter.
[0013] In one embodiment each primary stimulating electrode comprises an electrically conductive
band extending around the catheter. Preferably, each primary stimulating electrode
comprises an electrically conductive band extending completely around the catheter.
Advantageously, each primary receiving electrode comprises an electrically conductive
band extending around the catheter.
Ideally, each primary receiving electrode comprises an electrically conductive band
extending completely around the catheter.
[0014] In one embodiment a primary electrically conductive means is electrically coupled
to the at least one primary stimulating electrode and to the at least one primary
receiving electrode, the primary electrically conductive means being adapted for communicating
a stimulating signal to the at least one primary stimulating electrode, and for receiving
a resulting signal from the at least one primary receiving electrode in response to
the stimulating signal. Preferably, the primary electrically conductive means extends
to the proximal end of the catheter. Advantageously, a primary axial wire accommodating
bore extends through the catheter from the proximal end thereof for accommodating
the primary electrically conductive means from the proximal end of the catheter to
the primary stimulating and receiving electrodes. Ideally, the primary electrically
conductive means comprises a plurality of mutually insulated primary electrically
conductive wires, each coupled to a corresponding one of the primary stimulating and
receiving electrodes.
[0015] In another embodiment the primary expandable element comprises at least two primary
balloons located adjacent each other on the catheter, each primary balloon defining
a hollow interior region through which the catheter extends, and a primary measuring
means being located in each primary balloon for determining the transverse cross-sectional
area of the corresponding primary balloon.
[0016] Preferably, the respective primary balloons are inflatable independently of each
other, and respective primary inflating medium accommodating means are provided for
the respective primary balloons for independent inflating thereof.
[0017] Advantageously, the primary expandable element is adapted for locating in a lower
oesophageal sphincter for use in a procedure for enhancing the biomechanical function
of the lower oesophageal sphincter.
[0018] In one embodiment the primary expandable element is adapted for locating in a lower
oesophageal sphincter for use in a fundoplication procedure.
[0019] In another embodiment a stimulating means is provided for stimulating the sphincter
to dilate when the primary expandable element is operated in the second mode. Preferably,
the stimulating means comprises a secondary expandable element located on the catheter.
Advantageously, the secondary expandable element is located on the catheter intermediate
the primary expandable element and the proximal end of the catheter. Ideally, the
secondary expandable element is axially spaced apart from the primary expandable element.
[0020] In one embodiment the secondary expandable element comprises a secondary inflatable
balloon defining a hollow interior region, with the catheter extending through the
hollow interior region thereof, the secondary balloon being inflatable independently
of the primary balloon. Preferably, the secondary balloon is located coaxially with
the catheter.
[0021] In another embodiment a secondary inflating medium accommodating means is provided
for accommodating an inflating medium to the secondary balloon for inflating thereof.
Preferably, the secondary inflating medium accommodating means comprises a secondary
axial communicating bore extending through the catheter from the proximal end thereof
and communicating with the hollow interior region of the secondary balloon for accommodating
the inflating medium to the secondary balloon for inflating thereof. Advantageously,
at least one secondary radial communicating bore extending through the catheter communicates
the secondary axial communicating bore with the hollow interior region of the secondary
balloon.
[0022] In another embodiment a secondary measuring means is provided for measuring the transverse
cross-sectional area of the secondary balloon. Preferably, the secondary measuring
means is located in the hollow interior region of the secondary balloon. Advantageously,
the secondary measuring means comprises at least one secondary stimulating electrode
located on one of the catheter and the inner surface of the secondary balloon and
at least one secondary receiving electrode located on one of the catheter and the
inner surface of the secondary balloon and axially spaced apart and insulated from
the secondary stimulating electrode, the at least one secondary receiving electrode
being responsive to a stimulating signal applied to the at least one secondary stimulating
electrode for producing a resulting signal indicative of the transverse cross-sectional
area of the secondary balloon when the secondary balloon is inflated with an electrically
conductive inflating medium. Ideally, a pair of axially spaced apart mutually insulated
secondary stimulating electrodes are provided, and a plurality of axially spaced apart
mutually insulated secondary receiving electrodes are provided between the secondary
stimulating electrodes and axially spaced apart therefrom for producing respective
resulting electrical signals indicative of the transverse cross-sectional area of
the secondary balloon adjacent the corresponding secondary receiving electrodes in
response to a stimulating signal applied across the secondary stimulating electrodes
when the secondary balloon is inflated with an electrically conductive inflating medium.
[0023] In one embodiment each secondary stimulating electrode and each secondary receiving
electrode is located on the catheter. Preferably, each secondary stimulating electrode
comprises an electrically conductive band extending around the catheter. Advantageously,
each secondary stimulating electrode comprises an electrically conductive band extending
completely around the catheter. Preferably, each secondary receiving electrode comprises
an electrically conductive band extending around the catheter. Ideally, each secondary
receiving electrode comprises an electrically conductive band extending completely
around the catheter.
[0024] In one embodiment a secondary electrically conductive means is electrically coupled
to the at least one secondary stimulating electrode and to the at least one secondary
receiving electrode, the secondary electrically conductive means being adapted for
communicating a stimulating signal to the at least one secondary stimulating electrode,
and for receiving a resulting signal from the at least one secondary receiving electrode
in response to the stimulating signal. Preferably, the secondary electrically conductive
means comprises a plurality of mutually insulated electrically conductive wires coupled
to the respective secondary stimulating and receiving electrodes. Advantageously,
the secondary electrically conductive wires are accommodated from the proximal end
of the catheter to the corresponding respective secondary stimulating and receiving
electrodes through the primary axial wire accommodating bore.
[0025] In one embodiment at least one secondary radial wire accommodating bore extends radially
through the catheter from the primary axial wire accommodating bore for accommodating
the secondary electrically conductive wires from the primary axial wire accommodating
bore to the secondary stimulating and receiving electrodes.
[0026] In one embodiment the secondary expandable element is adapted for simulating a bolus
of food in the oesophagus for stimulating the lower oesophageal sphincter for dilating
thereof.
[0027] An example also provides a system for use in a procedure for improving a sealing
function of a sphincter, the system comprising a device according to examples, and
a control means, the control means being adapted to selectively and alternately operate
the primary expandable element in the first mode and the second mode, and to operate
the primary measuring means to produce a signal indicative of the transverse cross-sectional
area of the primary expandable element when the primary expandable element is being
operated in the first mode and the second mode.
[0028] In one embodiment a display means operating under the control of the control means
is provided for displaying an image representative of the primary expandable element
for providing the indication of the transverse cross-sectional area of the sphincter
while the procedure is being carried out. Preferably, the display means is operated
under the control of the control means for displaying the image representative of
the primary expandable element as a three-dimensional representation. Advantageously,
the display means is operated under the control of the control means for displaying
the diameter of the primary expandable element at at least one transverse cross-section
thereof.
[0029] In one embodiment the display means is operated under the control of the control
means for displaying the diameter of the primary expandable element at a plurality
of axially spaced apart transverse cross-sections thereof.
[0030] In one embodiment a primary inflating means is provided for inflating the primary
balloon with an inflating medium. Preferably, the primary inflating means is operable
for maintaining the primary balloon at one of substantially constant volume and substantially
constant pressure when the primary expandable element is being operated in the first
mode.
Advantageously, the primary inflating means is operable for maintaining the primary
balloon at one of substantially constant volume and substantially constant pressure
when the primary expandable element is operating in the second mode.
[0031] In one embodiment a primary inflating medium accommodating means is provided for
accommodating the inflating medium from the primary inflating means to the primary
balloon for inflating thereof.
Advantageously, the control means is responsive to the resulting signals on the at
least one primary receiving electrodes for determining the transverse cross-sectional
area of the primary balloon.
[0032] In another embodiment a primary electrically conductive means electrically couples
the at least one primary stimulating electrode and the at least one primary receiving
electrode to the control means for communicating one of a stimulating voltage signal
and a stimulating current signal to the at least one primary stimulating electrode,
and for receiving a resulting signal from the at least one primary receiving electrode
in response to the stimulating signal.
Advantageously, the primary electrically conductive means extends from the primary
stimulating and receiving electrodes to the proximal end of the catheter for coupling
to the control means.
Ideally, the display means is adapted for displaying an image representative of the
respective balloons.
[0033] In another embodiment the control means is responsive to the signal from the secondary
measuring means for determining the transverse cross-sectional area of the secondary
balloon.
[0034] Preferably, the display means is operated under the control of the control means
for displaying an image representative of the secondary balloon. Advantageously, the
display means is operated under the control of the control means for displaying the
image representative of the secondary balloon as a three-dimensional representation.
[0035] In one embodiment the display means is operated under the control of the control
means for displaying the diameter of the secondary balloon at at least one transverse
cross-section thereof.
[0036] Preferably, the display means is operated under the control of the control means
for displaying the diameter of the secondary balloon at a plurality of axially spaced
apart transverse cross-sections thereof.
[0037] In another embodiment the at least one secondary receiving electrode is responsive
to a stimulating signal applied by the control means to the at least one secondary
stimulating electrode for producing the resulting signal indicative of the transverse
cross-sectional area of the secondary balloon when the secondary balloon is inflated
with an electrically conductive inflating medium. Preferably, the secondary receiving
electrodes produce respective resulting signals indicative of the transverse cross-sectional
area of the secondary balloon adjacent the corresponding secondary receiving electrodes
in response to a stimulating signal applied by the control means across the secondary
stimulating electrodes when the secondary balloon is inflated with an electrically
conductive inflating medium.
[0038] In another embodiment a secondary electrically conductive means electrically couples
the at least one secondary stimulating electrode and the at least one secondary receiving
electrode to the control means for communicating one of a stimulating voltage signal
and a stimulating current signal to the at least one secondary stimulating electrode,
and for receiving a resulting signal from the at least one secondary receiving electrode
in response to the stimulating signal.
Preferably, the secondary electrically conductive means comprises a plurality of mutually
insulated electrically conductive wires coupled to the respective secondary stimulating
and receiving electrodes and to the control means.
[0039] In another embodiment a secondary pressure monitoring means is provided for monitoring
the pressure of the inflating medium in the secondary balloon.
[0040] In a further embodiment the secondary expandable element is adapted for simulating
a bolus of food in the oesophagus for stimulating the lower oesophageal sphincter
for dilating thereof when the primary expandable element is being operated in the
second mode.
[0041] In another embodiment a primary pressure monitoring means is provided for monitoring
the pressure of the inflating means in the primary balloon.
[0042] In one embodiment the system is adapted for use in carrying out a procedure for enhancing
the biomechanical function of the lower oesophageal sphincter.
[0043] In another embodiment the system is adapted for use in a fundoplication procedure.
[0044] In a further embodiment the system is adapted for use in determining the dilated
transverse cross-sectional area of a lower oesophageal sphincter in response to stimulation
thereof.
[0045] Further an example provides use of the device according to the invention in a procedure
for enhancing the biomechanical function of the lower oesophageal sphincter.
[0046] An example further provides use of the device according to the invention in a fundoplication
procedure.
[0047] An example also provides use of the device according to the invention in determining
the dilated transverse cross-sectional area of a lower oesophageal sphincter in response
to stimulation thereof.
[0048] An example also provides use of the system according to the invention in a procedure
for enhancing the biomechanical function of the lower oesophageal sphincter.
[0049] Further an example provides use of the system according to the invention in a fundoplication
procedure.
[0050] An example also provides use of the system according to the invention in determining
the dilated transverse cross-sectional area of a lower oesophageal sphincter in response
to stimulation thereof.
[0051] The advantages of the invention are many. The system according to the invention provides
a surgeon with a positive and accurate indication of the amount to which the sphincter
would be permitted to dilate after carrying out the procedure to improve the sealing
function of the sphincter. Where the system and the device not covered by the claims
are used in a fundoplication procedure, the surgeon is provided with a positive and
accurate indication of the amount to which the lower oesophageal sphincter will dilate
after the fundoplication procedure has been carried out. This is due to the fact that
when wrapping the fundus of the stomach around the lower portion of the oesophagus
adjacent the lower oesophageal sphincter, the amount of restriction which will be
caused to the sphincter can be monitored as the fundus is being wrapped around the
sphincter, and accordingly, the fundus can be sutured at the appropriate placement
which permits dilation of the sphincter to the desired transverse cross-sectional
area by merely observing the image of the primary expandable element and the relevant
diameter values of the balloon adjacent the centre thereof when the centre of the
primary balloon is aligned with the sphincter.
[0052] A further and important advantage of the examples is that it permits the dilation
response of the sphincter to a simulated bolus of food to be tested both during and
after the fundoplication procedure.
[0053] A particularly important advantage of the system is that it permits a visual representation
of the expandable element, which should provide a reasonable representation of the
transverse cross-sectional area of the sphincter to be viewed by the surgeon or paramedic
during carrying out of the procedure for improving the sealing function of the sphincter
or enhancing the biomechanical function thereof, and also during testing of the dilating
function of the sphincter. Thus, a surgeon can observe the image during the procedure
for improving the sealing function of the sphincter, and where the sphincter is being
tightened during the procedure, the surgeon can observe how the tightening of the
sphincter affects the transverse cross-sectional area thereof, and can set the tightening
of the sphincter when the dilated sphincter is at the desired transverse cross-sectional
area. Additionally, the surgeon or paramedic, as the case may be, can readily observe
the dilating response of the sphincter by observing the image of the balloon as the
sphincter is dilating in response to a stimulus.
[0054] The invention is defined by the system of independent claim 1.
[0055] The invention will be more clearly understood from the following description of some
preferred embodiments thereof, which are given by way of example only, with reference
to the accompanying drawings, in which:
Fig. 1 is a block representational view of a system according to the invention for
use in a procedure for improving a sealing function of a sphincter, and which includes
a device for use in a procedure for improving the sealing function of a sphincter,
Fig. 2 is a transverse cross-sectional elevational view of the device of the system
of Fig. 1,
Fig. 3 is an end elevational view of the device of Fig. 2,
Fig. 4 is a diagrammatic view of the device of Fig. 1 in use,
Fig. 5 is a block representation of a system according to another embodiment for use
in a procedure for improving the sealing function of a sphincter, and
Fig. 6 is a view similar to Fig. 2 of a device according to another embodiment for
use with the systems of Figs. 1 and 5 in a procedure for improving the sealing function
of a sphincter.
[0056] Referring to the drawings and initially to Figs. 1 to 4 thereof, there is illustrated
a system according to the invention, indicated generally by the reference numeral
1, for use in a procedure for improving a sealing function or for enhancing the biomechanical
function of a sphincter. The system 1 comprises a device also according to examples,
indicated generally by the reference numeral 3, for use in the procedure. The system
1 and the device 3 in this embodiment are suitable for use in a fundoplication procedure
whereby the sealing function of the lower oesophageal sphincter 5 is corrected. The
system 1 also comprises control and analysing apparatus 4, and under the control of
the control and analysing apparatus 4 the system 1 and the device 3 are selectively
operable in a first mode for dilating the sphincter 5 and in a second mode for testing
the dilating response of the sphincter 5 to a simulated bolus of food in the oesophagus
7 as will be described below.
[0057] In a fundoplication procedure the fundus, namely, an upper portion of the stomach
6 is wrapped around a lower portion of the oesophagus 7 adjacent the sphincter 5 and
sutured in place in order to augment the biomechanical function of the sphincter 5.
The device 3 dilates the sphincter 5 to a desired transverse cross-sectional area
and displays an image which is representative of the transverse cross-sectional area
of the sphincter while the procedure is being carried out, which can be observed by
the surgeon carrying out the procedure as the fundus is being tightened around the
oesophagus 7 adjacent the sphincter 5, so that the surgeon can observe the effect
of tightening of the fundus around the oesophagus on the sphincter, and can suture
the fundus when the dilated sphincter 5 is at the desired transverse cross-sectional
area. This, thus, avoids over-tightening of the fundus around the sphincter 5. The
system 1 and the device 3 are also suitable for testing dilation of the sphincter
5 of the fundoplication procedure as will be described below. Before describing the
system 1 in further detail, the device 3 will first be described.
[0058] The device 3 comprises an elongated catheter 8 extending from a proximal end 9 to
a distal end 10 for inserting into the oesophagus 7 nasally or orally. A primary expandable
element, namely, an inflatable primary balloon 12 defining a hollow interior region
14 is located on the catheter 8 adjacent the distal end 10 thereof with the catheter
8 extending through the hollow interior region 14 thereof. In this embodiment of the
invention the primary balloon 12 when inflated is of cylindrical configuration and
defines a central longitudinally extending balloon axis 15 which coincides with a
longitudinally extending central axis 16 of the catheter 8. The primary balloon 12
is sealably secured to the catheter 8 at its respective opposite ends 18 and 19, and
is provided thereon for locating within the sphincter 5 for dilating the sphincter
5 to the desired transverse cross-sectional area during the fundoplication procedure.
The primary balloon 12 is also operable, as will be described below, when inflated
to expand with the sphincter 5 so that the transverse cross-sectional area to which
the sphincter 5 dilates when stimulated to dilate can be determined.
[0059] A primary inflating medium accommodating means, in this embodiment of the invention
an elongated primary axial communicating bore 20 extends longitudinally through the
catheter 8 from the proximal end 9 to the distal end 10 thereof for accommodating
an inflating medium, which in this case is an electrically conductive medium, and
preferably, a saline solution, for inflating the primary balloon 12. A plurality of
primary radial communicating bores 21 extend radially through the catheter 8 within
the hollow interior region 14 of the primary balloon 12, and communicate with the
primary axial communicating bore 20 for accommodating the inflating medium between
the primary axial communicating bore 20 and the hollow interior region 14 of the primary
balloon 12. The catheter 8 terminates in an epoxy plug 24 which sealably closes the
distal end of the primary axial communicating bore 20.
[0060] A primary inflating means for inflating the primary balloon 12 with the inflating
medium comprises a primary pump 26 located in the control and analysing apparatus
4 which pumps the inflating medium between a reservoir 25 and the primary balloon
12 for inflating and deflating the balloon 12. The primary pump 26 is operated under
the control of the control and analysing apparatus 4 as will be described below, and
is coupled to the primary axial communicating bore 20 at the proximal end 9 of the
catheter 8 by a conduit 28 and to the reservoir 25 by a conduit 29. A primary pressure
monitoring means comprising a primary pressure sensor and a primary pressure gauge
30 in the conduit 28 monitors the pressure of the inflating medium in the conduit
28 and in turn in the hollow interior region 14 of the primary balloon 12.
[0061] A primary measuring means for determining the transverse cross-sectional area of
the primary balloon 12 at axially spaced apart locations along the central axis 15
thereof comprises a pair of axially spaced apart mutually insulated electrically conductive
stimulating electrodes 32 located on an outer surface 33 of the catheter 8 for receiving
a stimulating voltage signal or a stimulating current signal from the control and
analysing apparatus 4 as will be described below. In this case the stimulating signal
is a stimulating current signal of constant known current. The stimulating electrodes
32 are located on the catheter 8 in the hollow interior region 14 of the primary balloon
12 adjacent the respective axially opposite ends 18 and 19 of the primary balloon
12.
[0062] A plurality of mutually insulated electrically conductive primary receiving electrodes
35 in this case ten primary receiving electrodes 35 are located axially spaced apart
on the outer surface 33 of the catheter 8 within the hollow interior region 14 of
the primary balloon 12 and between and spaced apart from the primary stimulating electrodes
32. In this embodiment of the invention the primary stimulating electrodes 32 and
the primary receiving electrodes 35 are provided by electrically conductive band electrodes
which extend circumferentially around and are bonded to the catheter 8. The primary
receiving electrodes 35 are equi-spaced apart from each other, and in this case the
spacing between the primary stimulating electrodes 32 and the adjacent primary receiving
electrodes 35 is similar to the spacing between the primary receiving electrodes 35.
[0063] When the primary balloon 12 is inflated with the electrically conductive medium,
resulting voltage signals appear on the primary receiving electrodes 35 in response
to the stimulating current signal which is applied to the primary stimulating electrodes
32, and the resulting voltage signals appearing on the primary receiving electrodes
35 are indicative of the transverse cross-sectional area of the primary balloon 12
at the respective axially spaced apart locations corresponding to the locations of
the respective primary receiving electrodes 35 along the catheter 8.
[0064] A primary electrically conductive means for applying the stimulating current signal
to the primary stimulating electrodes 32 and for receiving the resulting voltage signals
from the primary receiving electrodes 35 when the primary balloon 8 is inflated with
the electrically conductive medium comprises a plurality of mutually insulated electrically
conductive primary wires 37 which are electrically coupled to the primary stimulating
and receiving electrodes 32 and 35. In this embodiment of the invention a separate
primary wire 37 is provided to each primary stimulating electrode 32 and to each primary
receiving electrode 35. A primary axial wire accommodating bore 38 extending through
the catheter 8 from the proximal end 9 and primary radial wire accommodating bores
39 extending from the primary axial wire accommodating bore 38 into the hollow interior
region 14 of the balloon 12 accommodate the primary wires 37 from the proximal end
9 of the catheter 8 to the primary stimulating and receiving electrodes 32 and 35.
[0065] A constant current signal generator 40 located in the control and analysing apparatus
4 applies the stimulating current signal to the primary stimulating electrodes 32
under the control of a control means, namely, a microprocessor 43. The microprocessor
43 reads the resulting voltage signals from the primary receiving electrodes 35 from
which the microprocessor 43 determines the transverse cross-sectional area and in
turn approximate values of the diameter of the balloon 12 at the respective axially
spaced apart locations corresponding to the respective locations of the primary receiving
electrodes 35.
[0066] A visual display means, namely, a visual display screen 45 in the control and analysing
apparatus 4 under the control of a graphics processor 46 displays an image 47 which
is representative of the primary balloon 12. Additionally, under the control of the
graphics processor 46 the respective diameters of the primary balloon 12 at the axial
spaced apart locations corresponding to the locations of the primary receiving electrodes
35 are displayed in windows 48 on the visual display screen 45 adjacent the corresponding
location relative to and adjacent the image 47. The computed values of the diameter
of the primary balloon 12 at the locations corresponding to the locations of the primary
receiving electrodes 35 which are determined by the microprocessor 43 are applied
to the graphics processor 46, which in turn generates the image 47 representative
of the primary balloon 12 for display on the visual display screen 45 along with the
diameter values in the windows 48.
[0067] The signals from the primary receiving electrodes 35 are applied to respective analogue-to-digital
converters 49 in the control and analysing apparatus 4, and the digital values of
the voltage signals are read from the corresponding analogue-to-digital converters
49 by the microprocessor 43, which in turn determines the respective values of the
transverse cross-sectional area of the primary balloon 12 and in turn the corresponding
approximate values of the diameter of the primary balloon 12 at the locations corresponding
to the locations of the receiving electrodes 35.
[0068] The primary pump 26 is also operated under the control of the microprocessor 43 for
inflating and deflating the primary balloon 12 and for controlling the volume and
pressure to which the primary balloon 12 is inflated in response to signals from the
primary pressure sensor and gauge 30, which are read by the microprocessor 43.
[0069] A secondary expandable element, namely, a secondary inflatable balloon 50 defining
a hollow interior region 51 is located on the catheter 8 spaced apart from the primary
balloon 12 intermediate the proximal end 9 of the catheter 8 and the primary balloon
12 with the catheter 8 extending through the hollow interior region 51 of the secondary
balloon 50. The secondary balloon 50 when inflated is of cylindrical configuration.
In this embodiment of the invention the secondary balloon 50 is located on the catheter
8 at a distance of approximately 200mm from the primary balloon 12, so that when the
primary balloon 12 is axially centrally located in the sphincter 5 the secondary balloon
50 is located in the oesophagus for simulating a bolus of food in the oesophagus 7
upstream of the sphincter 5. The simulation of the bolus of food in the oesophagus
by the secondary balloon 50 stimulates the sphincter 5 to dilate, so that with the
primary balloon 12 located in the sphincter 5, the amount by which the sphincter 5
dilates in response to the simulated bolus of food can be determined, in order to
permit a surgeon to test the tightness to which the fundus has been tightened around
the oesophagus 7 adjacent the sphincter 5. This test can be carried out either during
or subsequent to the fundoplication procedure. The use of the system 1 and the device
5 for determining the transverse cross-sectional area to which the sphincter 5 dilates
in response to a simulated bolus of food is described in more detail below.
[0070] A secondary inflating means for inflating the secondary balloon 50 independently
of the primary balloon 12 comprises a secondary pump 55 located in the control and
analysing apparatus 4, which is operated under the control of the microprocessor 43.
A secondary axial communicating bore 53 extending through the catheter 8 from the
proximal end 9 thereof and a pair of secondary radial communicating bores 54 which
communicate the secondary axial communicating bore 53 with the hollow interior region
51 of the secondary balloon 50. The secondary axial communicating bore 53 is isolated
from the primary axial communicating bore 20. The secondary pump 55 delivers the inflating
medium between the reservoir 25 and the hollow interior region 55 of the secondary
balloon 50 through the axial secondary communicating bore 5 and the radial secondary
communicating bores 54 for inflating and deflating the secondary balloon 50. A conduit
56 couples the secondary pump 55 and the secondary axial communicating bore 53 adjacent
the proximal end 9 thereof. A conduit 57 couples the reservoir 25 to the secondary
pump 55. A secondary pressure monitoring means comprises a secondary pressure sensor
and a secondary pressure gauge 58 located on the conduit 56 for displaying the pressure
of the inflating medium in the conduit 56, and in turn the pressure of the inflating
medium in the secondary balloon 50. The microprocessor 43 reads signals from the secondary
pressure sensor and gauge 58 for controlling the pressure to which the secondary balloon
12 is inflated.
[0071] In this embodiment of the invention a secondary measuring means provided by a pair
of axially spaced apart secondary stimulating electrodes 60 located on the outer surface
33 of the catheter 8 in the hollow interior region 51 of the secondary balloon 50.
One secondary receiving electrode 61 is located on the outer surface 33 of the catheter
8 between the secondary stimulating electrodes 60 and equi-spaced apart from the respective
secondary electrodes 60. The secondary stimulating electrodes 60 and the secondary
receiving electrode 61 are similar to the primary stimulating electrodes 32 and the
primary receiving electrodes 35, respectively, and their use in determining the transverse
cross-sectional area of the secondary balloon 50 adjacent the secondary receiving
electrode 61 is similar to the use of the primary stimulating and receiving electrodes
32 and 35 in determining the transverse cross-sectional area of the primary balloon
adjacent the locations of the primary receiving electrodes 35.
[0072] A secondary communicating means, namely, mutually insulated secondary electrically
conductive wires 63 which are electrically coupled to the secondary stimulating and
receiving electrodes 60 and 61 are accommodated through secondary radial wire accommodating
bores 64 into the primary axial wire accommodating bore 38 to the proximal end 9 thereof.
The secondary wires 63 which are electrically coupled to the secondary stimulating
electrodes 60 are coupled to the constant current signal generator 40 for applying
a stimulating constant current signal to the secondary stimulating electrodes 60 under
the control of the microprocessor 43. The secondary wire 63 which is coupled to the
secondary receiving electrode 61 is coupled to an analogue-to-digital converter 65
for converting the resulting voltage signal on the secondary receiving electrode 61
in response to the stimulating current signal applied to the secondary stimulating
electrode 60 to a digital value. The microprocessor 43 reads the digital value of
the resulting voltage signal from the analogue-to-digital converter 65, and determines
the transverse cross-sectional area of the secondary balloon 50 therefrom adjacent
the secondary receiving electrode 60, and in turn an approximate value of the diameter
of the secondary balloon 50. The microprocessor 43 applies the computed value of the
diameter of the secondary balloon 50 to the graphics processor 46, which in turn displays
an image 67 which is representative of the secondary balloon 50 on the visual display
screen 45 as well as the diameter value thereof in a window 68.
[0073] In this embodiment to ensure that the primary and secondary balloons 12 and 50 are
independently inflatable relative to each other, the primary and secondary wires 37
and 63 are sealed in the corresponding primary and secondary radial wire accommodating
bores 39 and 64 in order to avoid inflating medium from the hollow interior regions
14 and 51 of the respective primary and secondary balloons 12 and 50 leaking into
the primary axial wire accommodating bore 38, and in turn between the respective primary
and secondary balloons 12 and 50, respectively.
[0074] While in this embodiment the secondary balloon 50 has been provided with a secondary
measuring means in the form of the secondary stimulating and receiving electrodes
60 and 61, in many cases, it will not be necessary to know the diameter to which the
secondary balloon 50 is inflated, and in such cases, the secondary measuring means,
including the secondary stimulating and receiving electrodes 60 and 61 may be omitted.
[0075] In use, with the device 3 coupled to the control and analysing apparatus 4 so that
the primary and secondary pumps 26 and 55 are coupled to the primary and secondary
axial communicating bores 20 and 53, respectively, and the primary and secondary wires
37 and 63 which are coupled to the primary and secondary stimulating electrodes 32
and 60 coupled to the constant current signal generator 40, and the primary and secondary
wires 37 and 63 which are coupled to the primary and secondary receiving electrodes
35 and 61 coupled to the analogue-to-digital converters 49 and 65, respectively, the
control and analysing apparatus 4 and the device 3 are ready for use. With the primary
and secondary balloons 12 and 50 deflated, the distal end 10 of the catheter 8 of
the device 3 is entered into the oesophagus 7 either nasally or orally, and is urged
downwardly through the oesophagus 7 until the primary balloon 12 is located in and
engaged by the sphincter 5.
[0076] When it is desired to maintain the sphincter 5 dilated during a fundoplication procedure,
the system 1 and the device 3 are operated in the first mode. The primary pump 26
under the control of the microprocessor 43 is operated to commence inflating the primary
balloon 12 with the electrically conductive medium, which in this case is the saline
solution from the reservoir 25. Simultaneously the microprocessor 43 activates the
constant current signal generator 40 for generating the stimulating current signal
which is applied to and maintained on the primary stimulating electrodes 32. The microprocessor
43 reads the digital values of the resulting voltage signals on the primary receiving
electrodes 35 from the analogue-to-digital converters 49, and determines both the
transverse cross-sectional area of the primary balloon 12 and the approximate values
of the diameter of the primary balloon 12 at the axially spaced apart locations corresponding
to the locations of the receiving electrodes 35. The values of the transverse cross-sectional
area and the values of the diameter of the primary balloon 12 at the respective axially
spaced apart locations are applied to the graphics processor 46, which generates the
image 47 which is representative of the primary balloon 12, and which is displayed
on the visual display screen 45 along with the corresponding diameter values in the
windows 48.
[0077] As the primary balloon 12 is being inflated, the image 47 and the diameter values
in the windows 48 are continuously updated. During initial inflation of the primary
balloon 12, the catheter 8 is manoeuvred so that the primary balloon 12 is centred
axially within the sphincter 5, in other words, so that the sphincter 5 engages the
outer surface of the primary balloon 12 centrally equi-spaced from the axial opposite
ends 18 and 19 of the primary balloon 12. A surgeon carrying out the fundoplication
procedure observes the visual display screen 45 and when the transverse cross-sectional
area of the primary balloon 12 at the location of the sphincter corresponds to the
desired diameter to which the sphincter is to be dilated, the primary pump 26 is operated
for maintaining the volume of the primary balloon 12 substantially constant, and in
turn the transverse cross-sectional area of the primary balloon 12 substantially constant
for in turn maintaining the sphincter dilated to the desired diameter. The desired
diameter to which the sphincter is to be dilated is typically 10mm to 20mm.
[0078] Once the diameter of the sphincter 5 is being maintained constant by the primary
balloon 12, the surgeon wraps the fundus of the stomach around the lower portion of
the oesophagus 7 adjacent the sphincter 5. As the fundus is being manipulated around
the oesophagus, the diameter of the primary balloon 12 adjacent the location of the
sphincter 5 is observed on the visual display screen 45. During this part of the procedure
as the fundus is being tightened around the oesophagus, the diameter of the primary
balloon 12 varies as the fundus is tightened or loosened. Tightening or loosening
of the fundus continues until the diameter of the primary balloon 12 adjacent the
sphincter 5 is at the diameter value at which the fundus is to be sutured, and the
fundus is then sutured. Since the primary balloon 12 is inflated and is located in
the sphincter 5, the diameter of the balloon 12 adjacent the sphincter 5 is similar
to the diameter of the sphincter 5.
[0079] When the fundoplication procedure has been completed, the primary balloon 12 is deflated,
and if desired, at that stage the catheter 8 is removed from the subject with the
primary and secondary balloons 12 and 50 deflated.
[0080] However, if it is desired to test the dilation response of the sphincter 5 to a simulated
bolus of food, the system 1 and the device 3 are operated in the second mode. The
primary balloon 12 is again inflated with the saline solution by the primary pump
26 to a pressure or volume sufficient to engage the sphincter without dilating the
sphincter 5, but sufficient such that as the sphincter 5 dilates, the portion of the
primary balloon 12 adjacent the sphincter 5 expands with the sphincter 5, so that
the transverse cross-sectional area of the sphincter 5 can be determined from the
transverse cross-sectional area of the balloon 12 adjacent the sphincter 5. During
this inflation of the primary balloon 12 the pressure of the saline solution in the
primary balloon 12 is monitored on the primary pressure sensor and gauge 30 by the
microprocessor 43, which appropriately operates the primary pump 26 in response to
the monitored pressure. Once inflating of the primary balloon 12 commences, the signal
generator 40 is operated to apply and maintain the stimulating current signal on the
primary stimulating electrodes 32 so that the diameter of the primary balloon can
be determined at the axially spaced apart locations corresponding to the primary receiving
electrodes 35. The image 47 of the primary balloon 12 and the respective diameter
values thereof are displayed and continuously updated on the visual display screen
45. The secondary balloon 50 is then inflated with the saline solution by the secondary
pump 55 to simulate a bolus of food in the oesophagus. During inflating of the secondary
balloon 50, the stimulating current signal is applied to the secondary stimulating
electrodes 60 and the resulting voltage signal on the secondary receiving electrode
61 is read from the analogue-to-digital converter 65 by the microprocessor 43. The
image 67 of the inflating secondary balloon 50 is displayed and continuously updated
on the visual display screen 45 along with the diameter thereof, which is displayed
in the window 68. When the secondary balloon 50 has been inflated sufficiently to
simulate a bolus of food, the dilating response of the sphincter 5 to the simulated
bolus of food is observed on the visual display screen 45. If the sphincter 5 dilates
to the desired diameter, the fundus is deemed not to have been over-tightened around
the sphincter 5, thus allowing a bolus of food to pass through the sphincter 5 into
the stomach.
[0081] When testing of the dilating response of the sphincter to the bolus of food has been
completed, the primary and secondary balloons 12 and 50 are deflated and the catheter
8 is removed from the oesophagus.
[0082] During inflating of the secondary balloon 50, the pressure of the saline solution
therein is monitored on the secondary pressure sensor and gauge 58 in order to ensure
against excessive pressure on the wall of the oesophagus.
[0083] It will be appreciated that the system 1 and the device 3 may be used at any time
for testing the dilating response of a lower oesophageal sphincter to a simulated
bolus of food, irrespective of whether a fundoplication procedure has been carried
out.
[0084] In this embodiment the microprocessor 43 is programmed to determine the values of
the transverse cross-sectional area and the values of the diameter of the primary
balloon 12 at the locations corresponding to the locations of the primary receiving
electrodes 35 by determining the voltage drop between adjacent ones of the primary
receiving electrodes 35 and the voltage drop between the primary stimulating electrodes
32 and the adjacent primary receiving electrodes 35. Due to the fact that the voltage
drops between the adjacent primary receiving electrodes 35 and between the primary
stimulating and receiving electrodes 32 and 35 is a function of the impedance of the
saline solution between the respective primary stimulating and receiving electrodes
32 and 35, the values of the transverse cross-sectional area and the diameter of the
primary balloon 12 adjacent the corresponding primary receiving electrodes 35 is a
function of the voltage values thereon. The value of the transverse cross-sectional
area of the secondary balloon 50 adjacent the secondary receiving electrode 61 is
similarly determined by the microprocessor 43 as a function of the corresponding voltage
drop between the secondary stimulating and receiving electrodes 60 and 61.
[0085] Referring now to Fig. 5, there is illustrated a system indicated generally by the
reference numeral 70, also for use in carrying out a fundoplication procedure. The
system 70 is substantially similar to the system 1 and similar components are identified
by the same reference numerals. The system 70 comprises a device also for use in the
fundoplication procedure which is identical to the device 3 described with reference
to Figs. 1 to 4. The only difference between the system 70 and the system 1 is in
the application of the voltage signals from the primary receiving electrodes 35 to
the microprocessor 43. In this embodiment of the invention the voltage signals from
the primary receiving electrodes 35 are differentially applied to the analogue-to-digital
converters 49 through differential op-amps 71. The inverting and non-inverting inputs
of the op-amps 71 are coupled to adjacent ones of the primary receiving electrodes
35, and the outputs of the differential op-amps 71 are applied to the corresponding
analogue-to-digital converters 49, from which the digital values of the differential
voltages are read by the microprocessor 43. Otherwise, the system 70 and its use is
similar to the system 1 and the device 3.
[0086] Referring now to Fig. 6, there is illustrated a device according to another embodiment
indicated generally by the reference numeral 80, also for use in a fundoplication
procedure and for use in conjunction with either the system 1 or the system 70 described
with reference to Figs. 1 to 4, and Fig. 5, respectively. The device 80 is substantially
similar to the device 3 described with reference to Figs. 1 to 4 and similar components
are identified by the same reference numerals. The main difference between the device
80 and the device 1 is that in this embodiment the primary expandable element is provided
in the form of three primary balloons 12a, 12b and 12c. The primary balloons 12a,
12b and 12c are inflatable independently of each other by three primary pumps (not
shown) which are provided in the control and analysing apparatus 4. Three mutually
isolated primary axial communicating bores and primary radial communicating bores
are provided in the catheter 8 for communicating the respective primary balloons 12
with the corresponding primary pumps 26. Each primary balloon 12 is provided with
a primary measuring means which includes a pair of primary stimulating electrodes
32 and a plurality of primary receiving electrodes 35 similar to and similarly spaced
as the primary stimulating electrodes 32 and receiving electrodes 35 of the device
3 for facilitating a determination of the respective transverse cross-sectional areas
and diameters of the respective balloons 12 at locations corresponding to the respective
primary receiving electrodes 35.
[0087] The use of the device 80 is substantially similar to that of the device 3. However,
the advantage of providing the expandable element in the form of three primary balloons
12 facilitates a more accurate placement of the device 80 in the sphincter 5, so that
the central primary balloon 12b is axially aligned with the sphincter 5, and furthermore,
the provision of the three primary balloons 12 also facilitates a more accurate determination
of the dilated diameter of the sphincter 5, as well as more accurate dilating of the
sphincter 5.
[0088] Otherwise, use of the device 80 is similar to that of the device 3. While the systems
and devices have been described for use for dilating the lower oesophageal sphincter
at a desired transverse cross-sectional area during a fundoplication procedure, it
will be readily apparent to those skilled in the art that the device may be used for
dilating any sphincter during the carrying out of any procedure on the sphincter.
It will also be readily apparent to those skilled in the art that the systems and
devices may also be used for testing the dilating response of any other sphincter
in response to stimulation. Indeed, it will be readily apparent to those skilled in
the art that the system and device, and the method may be used for dilating the lower
oesophageal sphincter to a desired transverse cross-sectional area during any other
type of procedure for improving the sealing function of the lower oesophageal sphincter
or for enhancing the biomechanical function of the lower oesophageal sphincter.
[0089] While the device 3 has been described as being provided with ten primary receiving
electrodes, any number of primary receiving electrodes may be provided, and the number
of primary receiving electrodes will largely depend on the length of the primary balloon,
and the resolution required. Additionally, while two primary stimulating electrodes
have been provided in the device 3 and 80, in certain cases, a single primary stimulating
electrode may be sufficient.
[0090] While the secondary balloons have been described as comprising secondary stimulating
and receiving electrodes for facilitating a determination of the diameter of the secondary
balloon, in certain cases, it is envisaged that the secondary stimulating and receiving
electrodes may be omitted, and if it were desired to determine the diameter to which
the secondary balloons are inflated, the diameter could be determined by monitoring
the pressure to which the secondary balloon is inflated on the second pressure sensor
and gauge. In cases where secondary stimulating and receiving electrodes are omitted
from the secondary balloon, the inflating medium may be a non-electrically conductive
medium.
[0091] It will also be appreciated in certain embodiments the secondary balloon may be omitted,
where the systems and devices are solely provided for the purpose of dilating the
sphincter to a desired transverse cross-sectional area prior to and during a fundoplication
procedure.
[0092] It will of course be appreciated that any suitable electrically conductive inflating
media besides a saline solution may be used for inflating both the primary balloon
and the secondary balloon, and as discussed above, in certain cases, the inflating
medium for inflating the secondary balloon may be a non-electrically conductive inflating
medium.
[0093] While a primary and secondary inflating means have been described as being provided
by separate pumps, it is envisaged in certain cases, that a single pump may be provided
for inflating the respective primary and secondary balloons with the inflating medium,
and in which case, a suitable valving system would be provided for facilitating independent
inflating of the primary and secondary balloons by the single pump.
[0094] While the images representative of the primary and secondary balloons displayed on
the visual display screen has been described as being a three-dimensional image, it
will readily be apparent to those skilled in the art that any suitable image representative
of the balloons may be provided, for example, a longitudinal cross-sectional profile,
or any other suitable image. However, it will be appreciated that the images, while
they will be representative of the balloons, and may be representative of a three-dimensional
images of the respective balloons or longitudinal external profiles of the respective
balloons, the images may not be exact images, since while the balloons when inflated
in free air will inflate to a cylindrical configuration, nonetheless, the balloons
are of a deformable material, and thus, will adopt the shape of the sphincter or oesophagus
within which they are located, which may not be entirely of circular cross-section,
and thus, the images produced on the display screen, while they will be a reasonable
representation of the balloons, will not be an exact representation of the balloons.
[0095] While the balloons have been described as being of cylindrical configuration when
inflated, the balloons may be of any other shape, and may be of any other transverse
cross-section besides circular. For example, the balloons when inflated may be of
square, rectangular, triangular, hexagonal, polygonal or any other desired transverse
cross-section, and in certain cases, it is envisaged that the transverse cross-section
of the balloons may be matched to the cross-section of the lumen or cavity into which
they are to be inserted.
[0096] While respective wires from the primary receiving electrodes have been described
as extending through the catheter for coupling the primary receiving electrodes to
the corresponding analogue-to-digital converters in the control and analysing apparatus,
it is envisaged in certain cases that the number of primary wires may be reduced,
and in certain cases, may be reduced to one primary wire. In which case, the signals
on the primary receiving electrodes would be multiplexed along the single wire, or
the few wires to the corresponding analogue-to-digital converter. Similarly, a single
wire may be provided for coupling the secondary receiving electrodes in the secondary
balloon to the corresponding analogue-to-digital converter or converters, and multiplexing,
likewise, would be carried out. In such cases, it is envisaged that the multiplexer
would be provided in the balloon or balloons, as the case may be, or in the catheter
adjacent the balloon or balloons, as the case may be.
1. A system for use in a procedure for improving a sealing function of a sphincter, the
system comprising a catheter (8) extending between a proximal end (9) and a distal
end (10), a primary expandable element (12) located on the catheter (8) adjacent the
distal end (10) thereof for inserting in the sphincter, the primary expandable element
(12) comprising a primary inflatable balloon (12) defining the hollow interior region
(14), the catheter (8) extending through the hollow interior region (14) of the primary
balloon (12), a primary inflating means (26) comprising a primary pump (26) for inflating
the primary balloon (12) with an inflating medium, a primary pressure monitoring means
(30) comprising a primary pressure sensor and gauge (30) for monitoring the pressure
of the inflating medium in the primary balloon (12), a primary measuring means (32,35)
located in the hollow interior region (14) of the primary balloon (12) for producing
a signal indicative of the transverse cross-section of the primary balloon (12), and
a control means (4,43) comprising a microprocessor (43) responsive to signals from
the primary measuring means (32,35) for determining the transverse cross-sectional
area of the primary balloon (12), the primary pump (26) being operated under the control
of the microprocessor (43) for inflating and deflating the primary balloon (12) with
the inflating medium and for controlling the volume and pressure to which the primary
balloon (12) is inflated in response to signals read by the microprocessor (43) from
the primary pressure sensor and gauge (30), the primary balloon (12) being selectively
operable in
a first mode for dilating the sphincter to a desired transverse cross-sectional area,
and the primary measuring means (32,35) being operable for providing an indication
of the transverse cross-sectional area of the sphincter while the procedure for improving
the sealing function thereof is being carried out, and
a second mode for progressively expanding with the sphincter as the sphincter is dilating
for determining the dilated transverse cross-sectional area of the sphincter in response
to stimulation thereof, wherein in the second mode the primary balloon (12) is inflated
with the inflating medium by the primary pump (26) to a pressure or volume sufficient
to engage the sphincter without dilating the sphincter, but sufficient such that as
the sphincter dilates, the portion of the primary balloon (12) adjacent the sphincter
progressively expands with the sphincter, and the pressure of the inflating medium
in the primary balloon (12) is monitored on the primary pressure sensor and gauge
(30) by the microprocessor (43), which appropriately operates the primary pump (26)
in response to the monitored pressure.
2. A system as claimed in Claim 1 characterised in that a display means (45) operating under the control of the control means (4,43) is provided
for displaying an image representative of the primary balloon (12) for providing the
indication of the transverse cross-sectional area of the sphincter while the procedure
is being carried out.
3. A system as claimed in Claim 1 or 2 characterised in that the primary measuring means (32,35) comprises at least one primary stimulating electrode
(32) located on one of the catheter (8) and an inner surface of the primary balloon
(12) and at least one primary receiving electrode (35) located on one of the catheter
(8) and the inner surface of the primary balloon (12) and axially spaced apart and
insulated from the primary stimulating electrode (32), the at least one primary receiving
electrode (35) being responsive to a stimulating signal applied by the control means
to the at least one primary stimulating electrode (32) for producing a resulting signal
indicative of the transverse cross-sectional area of the primary balloon (12) when
the primary balloon (12) is inflated with an electrically conductive inflating medium.
4. A system as claimed in Claim 3 characterised in that a pair of axially spaced apart mutually insulated primary stimulating electrodes
(32) are provided, and a plurality of axially spaced apart mutually insulated primary
receiving electrodes (35) are provided between the primary stimulating electrodes
(32) and axially spaced apart therefrom for producing respective resulting signals
indicative of the transverse cross-sectional area of the primary balloon (12) adjacent
the corresponding primary receiving electrodes (35) in response to a stimulating signal
applied by the control means across the primary stimulating electrodes (32) when the
primary balloon (12) is inflated with an electrically conductive inflating medium.
5. A system as claimed in Claim 3 or 4 characterised in that each primary stimulating electrode (32) and each primary receiving electrode (35)
is provided on the catheter (8).
6. A system as claimed in any preceding claim characterised in that the primary balloon (12) comprises at least two primary balloons (12) located adjacent
each other on the catheter (8), each primary balloon (12) defining a hollow interior
region (14) through which the catheter (8) extends, and a primary measuring means
(32,35) being located in each primary balloon (12) for determining the transverse
cross-sectional area of the corresponding primary balloon (12).
7. A system as claimed in Claim 6 characterised in that the respective primary balloons (12) are inflatable independently of each other.
8. A system as claimed in any preceding claim characterised in that a stimulating means (50) is provided for stimulating the sphincter to dilate when
the primary balloon (12) is operating in the second mode.
9. A system as claimed in Claim 8 characterised in that the stimulating means (50) comprises a secondary expandable element (50) located
on the catheter (8).
10. A system as claimed in Claim 9 characterised in that the secondary expandable element (50) is located on the catheter (8) intermediate
the primary balloon (12) and the proximal end (9) of the catheter (8).
11. A system as claimed in Claim 9 or 10 characterised in that the secondary expandable element (50) is located axially spaced apart from the primary
balloon (12).
12. A system as claimed in any of Claims 9 to 11 characterised in that the secondary expandable element (50) comprises a secondary inflatable balloon (50)
defining a hollow interior region (51) with the catheter (8) extending through the
hollow interior region (51) thereof, the secondary balloon (50) being inflatable independently
of the primary balloon (12).
13. A system as claimed in Claim 12 characterised in that a secondary inflating means is provided for inflating the secondary balloon (50)
with an inflating medium when the primary balloon (12) is being operated in the second
mode.
1. System zur Verwendung in einem Verfahren zum Verbessern einer Abdichtfunktion eines
Schließmuskels, wobei das System umfasst: einen Katheter (8), der sich zwischen einem
proximalen Ende (9) und einem distalen Ende (10) erstreckt, ein primäres expandierbares
Element (12), das auf dem Katheter (8) angrenzend an dessen distales Ende (10) zum
Einführen in den Schließmuskel angeordnet ist, wobei das primäre expandierbare Element
(12) einen primären aufblasbaren Ballon (12) umfasst, der den hohlen Innenbereich
(14) definiert, der Katheter (8) sich durch den hohlen Innenbereich (14) des primären
Ballons (12) erstreckt, ein primäres Aufblasmittel (26), das eine primäre Pumpe (26)
zum Aufblasen des primären Ballons (12) mit einem Aufblasmedium umfasst, ein primäres
Drucküberwachungsmittel (30), das einen primären Drucksensor und ein Manometer (30)
zum Überwachen des Drucks des Aufblasmediums im primären Ballon (12) umfasst, ein
primäres Messmittel (32, 35), das im hohlen Innenbereich (14) des primären Ballons
(12) angeordnet ist, um ein Signal zu erzeugen, das den Querschnitt des primären Ballons
(12) angibt, und ein Steuermittel (4, 43), das einen Mikroprozessor (43) umfasst,
der auf Signale von dem primären Messmittel (32, 35) anspricht, um die Querschnittsfläche
des primären Ballons (12) zu bestimmen, wobei die primäre Pumpe (26) unter der Steuerung
des Mikroprozessors (43) betrieben wird, um den primären Ballon (12) mit dem Aufblasmedium
aufzublasen und zu entleeren, und um das Volumen und den Druck, auf die der primäre
Ballon (12) aufgeblasen wird, als Reaktion auf Signale zu steuern, die von dem Mikroprozessor
(43) von dem primären Drucksensor und Manometer (30) gelesen werden, wobei der primäre
Ballon (12) selektiv betreibbar ist in
einem ersten Modus zur Dilatation des Schließmuskels auf eine gewünschte Querschnittsfläche,
wobei das primäre Messmittel (32, 35) dazu betrieben werden kann, eine Angabe der
Querschnittsfläche des Schließmuskels bereitzustellen, während das Verfahren zum Verbessern
von dessen Abdichtfunktion ausgeführt wird, und
einem zweiten Modus zum progressiven Expandieren mit dem Schließmuskel, während sich
der Schließmuskel ausdehnt, um die dilatierte Querschnittsfläche des Schließmuskels
als Reaktion auf dessen Stimulation zu bestimmen, wobei in dem zweiten Modus der primäre
Ballon (12) mit dem Aufblasmedium durch die primäre Pumpe (26) auf einen Druck oder
ein Volumen aufgeblasen wird, der bzw. das ausreicht, um den Schließmuskel zu erfassen,
ohne den Schließmuskel zu dilatieren, aber ausreicht, dass sich der an den Schließmuskel
angrenzende Teil des primären Ballons (12) beim Ausdehnen des Schließmuskels progressiv
mit dem Schließmuskel ausdehnt, und der Druck des Aufblasmediums im primären Ballon
(12) an dem primären Drucksensor und Manometer (30) durch den Mikroprozessor (43)
überwacht wird, der die primäre Pumpe (26) als Reaktion auf den überwachten Druck
in geeigneter Weise betreibt.
2. System nach Anspruch 1, dadurch gekennzeichnet, dass ein Anzeigemittel (45), das unter der Steuerung des Steuermittels (4, 43) arbeitet,
zur Anzeige eines Bildes bereitgestellt ist, das repräsentativ für den primären Ballon
(12) ist, um die Angabe der Querschnittsfläche des Schließmuskels während der Durchführung
des Verfahrens bereitzustellen.
3. System nach Anspruch 1 oder 2, dadurch gekennzeichnet, dass das primäre Messmittel (32, 35) mindestens eine primäre Stimulationselektrode (32),
die sich entweder auf dem Katheter (8) oder auf einer Innenfläche des primären Ballons
(12) befindet, und mindestens eine primäre Empfangselektrode (35), die sich entweder
auf dem Katheter (8) oder auf der Innenfläche des primären Ballons (12) befindet und
von der primären Stimulationselektrode (32) axial beabstandet und isoliert ist, umfasst,
wobei die mindestens eine primäre Empfangselektrode (35) auf ein Stimulationssignal
anspricht, das durch das Steuermittel an die mindestens eine primäre Stimulationselektrode
(32) angelegt wird, um ein resultierendes Signal zu erzeugen, das die Querschnittsfläche
des primären Ballons (12) angibt, wenn der primäre Ballon (12) mit einem elektrisch
leitfähigen Aufblasmedium aufgeblasen wird.
4. System nach Anspruch 3, dadurch gekennzeichnet, dass ein Paar axial beabstandeter, gegeneinander isolierter primärer Stimulationselektroden
(32) bereitgestellt ist, und eine Vielzahl von axial voneinander beabstandeten, gegeneinander
isolierten primären Empfangselektroden (35) zwischen den primären Stimulationselektroden
(32) und axial davon beabstandet bereitgestellt ist, um jeweilige resultierende Signale
zu erzeugen, welche die Querschnittsfläche des primären Ballons (12) angrenzend an
die entsprechenden primären Empfangselektroden (35) als Reaktion auf ein Stimulationssignal
angeben, das durch das Steuermittel über die primären Stimulationselektroden (32)
angelegt wird, wenn der primäre Ballon (12) mit einem elektrisch leitfähigen Aufblasmedium
aufgeblasen wird.
5. System nach Anspruch 3 oder 4, dadurch gekennzeichnet, dass jede primäre Stimulationselektrode (32) und jede primäre Empfangselektrode (35) auf
dem Katheter (8) bereitgestellt ist.
6. System nach einem der vorstehenden Ansprüche, dadurch gekennzeichnet, dass der primäre Ballon (12) mindestens zwei primäre Ballons (12) umfasst, die aneinander
angrenzend auf dem Katheter (8) angeordnet sind, wobei jeder primäre Ballon (12) einen
hohlen Innenbereich (14) definiert, durch den sich der Katheter (8) erstreckt, und
ein primäres Messmittel (32, 35) in jedem primären Ballon (12) angeordnet ist, um
die Querschnittsfläche des entsprechenden primären Ballons (12) zu bestimmen.
7. System nach Anspruch 6, dadurch gekennzeichnet, dass die jeweiligen primären Ballons (12) unabhängig voneinander aufblasbar sind.
8. System nach einem der vorstehenden Ansprüche, dadurch gekennzeichnet, dass ein Stimulationsmittel (50) bereitgestellt ist, um das Dilatieren des Schließmuskels
zu stimulieren, wenn der primäre Ballon (12) im zweiten Modus arbeitet.
9. System nach Anspruch 8, dadurch gekennzeichnet, dass das Stimulationsmittel (50) ein sekundäres expandierbares Element (50) umfasst, das
auf dem Katheter (8) angeordnet ist.
10. System nach Anspruch 9, dadurch gekennzeichnet, dass das sekundäre expandierbare Element (50) auf dem Katheter (8) zwischen dem primären
Ballon (12) und dem proximalen Ende (9) des Katheters (8) angeordnet ist.
11. System nach Anspruch 9 oder 10, dadurch gekennzeichnet, dass das sekundäre expandierbare Element (50) axial beabstandet vom primären Ballon (12)
angeordnet ist.
12. System nach einem der Ansprüche 9 bis 11, dadurch gekennzeichnet, dass das sekundäre expandierbare Element (50) einen sekundären aufblasbaren Ballon (50)
umfasst, der einen hohlen Innenbereich (51) definiert, wobei sich der Katheter (8)
durch dessen hohlen Innenbereich (51) erstreckt, wobei der sekundäre Ballon (50) unabhängig
vom primären Ballon (12) aufblasbar ist.
13. System nach Anspruch 12, dadurch gekennzeichnet, dass ein sekundäres Aufblasmittel zum Aufblasen des sekundären Ballons (50) mit einem
Aufblasmedium bereitgestellt ist, wenn der primäre Ballon (12) im zweiten Modus betrieben
wird.
1. Système pour utilisation dans une procédure pour améliorer une fonction d'étanchéité
d'un sphincter, le système comprenant un cathéter (8) s'étendant entre une extrémité
proximale (9) et une extrémité distale (10), un élément expansible primaire (12) situé
sur le cathéter (8) adjacent à l'extrémité distale (10) de celui-ci pour insertion
dans le sphincter, l'élément expansible primaire (12) comprenant un ballonnet gonflable
primaire (12) définissant la région intérieure creuse (14), le cathéter (8) s'étendant
à travers la région intérieure creuse (14) du ballonnet primaire (12), un moyen de
gonflage primaire (26) comprenant une pompe primaire (26) pour gonfler le ballonnet
primaire (12) avec un milieu de gonflage, un moyen de surveillance de pression primaire
(30) comprenant un capteur de pression et manomètre primaire (30) pour surveiller
la pression du milieu de gonflage dans le ballonnet primaire (12), un moyen de mesure
primaire (32, 35) situé dans la région intérieure creuse (14) du ballonnet primaire
(12) pour produire un signal indicatif de la coupe transversale du ballonnet primaire
(12), et un moyen de commande (4, 43) comprenant un microprocesseur (43) qui réagit
à des signaux provenant du moyen de mesure primaire (32, 35) pour déterminer l'aire
en coupe transversale du ballonnet primaire (12), la pompe primaire (26) étant mise
en oeuvre sous la commande du microprocesseur (43) pour gonfler et dégonfler le ballonnet
primaire (12) avec le milieu de gonflage et pour commander le volume et la pression
auxquels le ballonnet primaire (12) est gonflé en réponse à des signaux lus par le
microprocesseur (43) provenant du capteur de pression et manomètre primaire (30),
le ballonnet primaire (12) étant sélectivement opérationnel dans
un premier mode pour dilater le sphincter à une aire en coupe transversale souhaitée,
et le moyen de mesure primaire (32, 35) étant opérationnel pour fournir une indication
de l'aire en coupe transversale du sphincter alors que la procédure pour améliorer
la fonction d'étanchéité de celui-ci est effectuée, et
un deuxième mode pour s'expanser progressivement avec le sphincter à mesure que le
sphincter se dilate pour déterminer l'aire en coupe transversale dilatée du sphincter
en réponse à une stimulation de celui-ci, dans lequel dans le deuxième mode le ballonnet
primaire (12) est gonflé avec le milieu de gonflage par la pompe primaire (26) à une
pression ou un volume suffisant pour venir en prise avec le sphincter sans dilater
le sphincter, mais suffisant de telle sorte qu'à mesure que le sphincter se dilate,
la partie du ballonnet primaire (12) adjacente au sphincter s'expanse progressivement
avec le sphincter, et la pression du milieu de gonflage dans le ballonnet primaire
(12) est surveillée sur le capteur de pression et manomètre primaire (30) par le microprocesseur
(43), qui actionne de façon appropriée la pompe primaire (26) en réponse à la pression
surveillée.
2. Système selon la revendication 1 caractérisé en ce qu'un moyen d'affichage (45) fonctionnant sous la commande du moyen de commande (4, 43)
est fourni pour afficher une image représentative du ballonnet primaire (12) pour
fournir l'indication de l'aire en coupe transversale du sphincter alors que la procédure
est effectuée.
3. Système selon la revendication 1 ou 2 caractérisé en ce que le moyen de mesure primaire (32, 35) comprend au moins une électrode de stimulation
primaire (32) située sur l'un parmi le cathéter (8) et une surface interne du ballonnet
primaire (12) et au moins une électrode de réception primaire (35) située sur l'un
parmi le cathéter (8) et la surface interne du ballonnet primaire (12) et axialement
espacée et isolée de l'électrode de stimulation primaire (32), l'au moins une électrode
de réception primaire (35) réagissant à un signal de stimulation appliqué par le moyen
de commande à l'au moins une électrode de stimulation primaire (32) pour produire
un signal résultant indicatif de l'aire en coupe transversale du ballonnet primaire
(12) lorsque le ballonnet primaire (12) est gonflé avec un milieu de gonflage électroconducteur.
4. Système selon la revendication 3 caractérisé en ce qu'une paire d'électrodes de stimulation primaires mutuellement isolées axialement espacées
(32) sont fournies, et une pluralité d'électrodes de réception primaires mutuellement
isolées axialement espacées (35) sont fournies entre les électrodes de stimulation
primaires (32) et axialement espacées de celles-ci pour produire des signaux résultants
respectifs indicatifs de l'aire en coupe transversale du ballonnet primaire (12) adjacent
aux électrodes de réception primaires correspondantes (35) en réponse à un signal
de stimulation appliqué par le moyen de commande à travers les électrodes de stimulation
primaires (32) lorsque le ballonnet primaire (12) est gonflé avec un milieu de gonflage
électroconducteur.
5. Système selon la revendication 3 ou 4 caractérisé en ce que chaque électrode de stimulation primaire (32) et chaque électrode de réception primaire
(35) sont fournies sur le cathéter (8).
6. Système tel que revendiqué dans l'une quelconque revendication précédente caractérisé en ce que le ballonnet primaire (12) comprend au moins deux ballonnets primaires (12) situés
l'un à côté de l'autre sur le cathéter (8), chaque ballonnet primaire (12) définissant
une région intérieure creuse (14) à travers laquelle le cathéter (8) s'étend, et un
moyen de mesure primaire (32, 35) se situant dans chaque ballonnet primaire (12) pour
déterminer l'aire en coupe transversale du ballonnet primaire correspondant (12).
7. Système selon la revendication 6 caractérisé en ce que les ballonnets primaires respectifs (12) sont gonflables indépendamment l'un de l'autre.
8. Système tel que revendiqué dans l'une quelconque revendication précédente caractérisé en ce qu'un moyen de stimulation (50) est fourni pour stimuler le sphincter à se dilater lorsque
le ballonnet primaire (12) fonctionne dans le deuxième mode.
9. Système selon la revendication 8 caractérisé en ce que le moyen de stimulation (50) comprend un élément expansible secondaire (50) situé
sur le cathéter (8).
10. Système selon la revendication 9 caractérisé en ce que l'élément expansible secondaire (50) se situe sur le cathéter (8) entre le ballonnet
primaire (12) et l'extrémité proximale (9) du cathéter (8).
11. Système selon la revendication 9 ou 10 caractérisé en ce que l'élément expansible secondaire (50) se situe axialement espacé du ballonnet primaire
(12).
12. Système selon l'une quelconque des revendications 9 à 11 caractérisé en ce que l'élément expansible secondaire (50) comprend un ballonnet gonflable secondaire (50)
définissant une région intérieure creuse (51) avec le cathéter (8) s'étendant à travers
la région intérieure creuse (51) de celui-ci, le ballonnet secondaire (50) étant gonflable
indépendamment du ballonnet primaire (12).
13. Système selon la revendication 12 caractérisé en ce qu'un moyen de gonflage secondaire est fourni pour gonfler le ballonnet secondaire (50)
avec un milieu de gonflage lorsque le ballonnet primaire (12) est mis en oeuvre dans
le deuxième mode.